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				<p class="content-title">SAMPLE RCM PROCESS</p>
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						<p class="paragraph">A patient calls the clinic to schedule an appointment for a no needle no scalpel vasectomy for birth control. 
							The receptionist gives the patient basic instructions regarding the procedure and asks him to accomplish the pre-registration 
							forms that can be downloaded from the clinic’s website. These forms should be submitted via mail, fax, or file upload portal 
							before the patient’s scheduled appointment.
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						<p class="paragraph">The pre-registration forms will detail the patient’s demographic, medical, and financial/coverage information. 
							The clinic may also ask for a deposit to reduce the number of “no shows,” which will be deducted from the patient’s bill upon registration.
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						<p class="paragraph">Once the forms and the deposit have been received by the clinic, the staff will review the forms and verify the benefits 
							covered in the patient’s insurance policy and estimate the amount the patient will pay for. The staff will also determine if the patient will 
							need pre-authorization.
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						<p class="paragraph">The staff will then call the patient to confirm receipt of the forms and inform him of his insurance deductible and co-pay 
							if he is eligible for the procedure. They will discuss the payment arrangement and determine the mode of payment the patient wishes to pay 
							with for his share of the bill. The staff will also give the patient instructions regarding the requirements for the procedure and reminds 
							him of the date and time of his scheduled appointment.
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						<p class="paragraph">When the patient arrives on the scheduled date and registers, the staff will ask for the patient’s identification card, 
							as well as his insurance card. At this time, the staff can also collect the balance of his fee or his insurance deductible and co-pay. 
							This payment is posted on his account along with the previous deposit.
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						<p class="paragraph">After the registration process, the patient’s vital signs will be recorded and his medical history will be reviewed by the doctor. 
							During consultation, the doctor will discuss the details of the procedure and answer any questions the patient may have. Afterwards, the doctor will confirm 
							if the patient understands the procedure and its possible risks. The doctor will also need to secure the patient’s signature on the consent form before he can 
							proceed with the vasectomy.
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						<p class="paragraph">Once the consent form has been signed and the doctor has endorsed the patient as fit for the procedure, the patient will be brought to 
							the operating room. After completing the vasectomy, the doctor will document the procedure done on the patient.
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						<p class="paragraph">Since a vasectomy is an outpatient procedure, the patient may get dressed and go home few minutes after the procedure. 
							He will be given written instructions for post-procedure care and may be prescribed with medications as needed.
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						<p class="paragraph">The staff can now code the clinical encounter for the no needle no scalpel vasectomy. This procedure is primarily coded 
							with CPT code 55450, ICD-9 Vol3 as 63.71. The diagnosis code V25.2 is appended to the vasectomy sterilization procedure. Evaluation and 
							management or sterilization consultations performed by the physician on the same day as the procedure itself require usage of the modifier 
							25 to the insurance claim. In addition, billing for surgical trays and local anesthesia supplies are commonly considered ‘bundled’ by most 
							insurance payers with the vasectomy procedure itself. Postoperatively, a sperm test will need to be performed before the patient can be 
							deemed ‘sterile’. These tests are also considered ‘bundled’ with the vasectomy procedure.
						</p>
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						<p class="paragraph">Once coding is done and charges have been captured, a claim form will be prepared and reviewed to ensure that it has no 
							defect or impropriety before it is submitted to the health insurance carrier. The claim is then sent electronically or manually. The staff 
							will monitor the status of the claim and will have to follow up with the health insurance carrier if a response is not received before the 
							maximum number of 30 days is reached.
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						<p class="paragraph">When the claim is rejected due to incomplete information, the claim will have to be corrected to include the required 
							information and resubmitted to the carrier.
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						<p class="paragraph">When the resubmitted claim is processed and the Explanation of Benefits (EOB) or Electronic Remittance Advice (ERA) 
							is received from the insurance carriers, it is reviewed to determine whether an appropriate reimbursement was made. Payments from the 
							insurance carrier are posted to the patient’s account.
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						<p class="paragraph">If there are additional patient payment obligations due, the provider must send out a patient statement to notify the patient 
							or their guarantor on the status of their account and the additional payment due. If the patient or guarantor does not respond to the initial 
							statement, additional “third-party letters” are sent to encourage payment. If payment is still not received after reasonable collection efforts, 
							it will be written off as bad debt.
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